Determining the best threshold of rapid shallow breathing index in a therapist-implemented patient-specific weaning protocol.

Background: For weaning patients from prolonged mechanical ventilation, we previously designed a respiratory-therapist-implemented weaning protocol that decreased median weaning time from 29 days to 17 days. An acceleration step at the start of the protocol allowed patients with a rapid shallow breathing index (RSBI) of < or = 80 to advance directly to spontaneous breathing trials (SBTs).

Methods: We prospectively evaluated whether calibrating the RSBI threshold allowed more patients to safely accelerate to the 1-hour SBT in the protocol, and whether that correlated with weaning duration and outcome.

Liberation from prolonged mechanical ventilation.

After weaning from PMV, patients are usually far from ready to resume normal activities. A prolonged recovery period after catastrophic illness is the rule, with multidisciplinary rehabilitation and discharge planning efforts. Following such efforts, reports of success of restorative care are institutional and population specific.

Post-ICU weaning from mechanical ventilation: the role of long-term facilities.

A review of the largest observational studies on post-ICU weaning from prolonged mechanical ventilation yields evidence that more than half of such patients can be successfully liberated from mechanical ventilation. Success is likely to fall within a 3-month window, with late successes and partial ventilator independence still possible thereafter. There is a uniformity of practice in finishing difficult weaning with self-breathing trials of increasing duration.

Approach to patients with long-term weaning failure.

Efforts to treat reversible disease processes that contribute to ventilator dependency in the intensive care unit (ICU) fail in up to 20% of patients, resulting in prolonged mechanical ventilation (PMV). Resolution of the insults that necessitated ICU admission and mechanical ventilation may be incomplete, and the economic pressure to transfer patients is ever increasing. The choice of post-ICU disposition depends on the patient's clinical condition, the resources of the transfer destination, and whether weaning attempts will continue.

The effect of tubing length, gas flow, and number of heaters on maximum gas temperature for aerosol circuits used for cold water near-drowning or hypothermia.

Background: Clinicians who treat patients suffering from cold water near-drowning or hypothermia routinely warm inspire gases greater than body temperature in accordance with care guidelines promulgated by the various organizations. However, humidifiers are designed to prevent heating gases beyond 41 C (assuming the use of a standard six foot aerosol circuit) in order to meet International Standards Organization regulations (ISO). Clinicians must modify equipment in order to deliver care.

Patient-ventilator trigger asynchrony in prolonged mechanical ventilation.

Study Objective: To investigate patient-ventilator trigger asynchrony (TA), its prevalence, physiologic basis, and clinical implications in patients requiring prolonged mechanical ventilation (PMV).

Study Design: Descriptive and prospective cohort study.

Setting: Barlow Respiratory Hospital (BRH), a regional weaning center.

Impact of renal dysfunction on weaning from prolonged mechanical ventilation.

BACKGROUND: In the intensive care unit (ICU) setting, the combination of mechanical ventilation and renal replacement therapy (RRT) has been associated with prolonged length of hospital stay, high cost of care and poor outcome. We gathered outcome data on patients who had severe renal dysfunction on transfer to our regional weaning center (RWC) for attempted weaning from prolonged mechanical ventilation (PMV). We screened the admission laboratory values of 1077 patients transferred to our RWC over an 8-year period.